Dr. Doctor's Little Back Book

Chapter

1

Introduction to the Diagnose and Treat Method

Even though a lot of information is available to the public regarding the general diagnosis and treatment of back pain, and many different medical practitioners deal with spine pain, I continue to see patients who show up in my office, hurting, without a specific diagnosis. They may already have had a lot of MRIs, physical therapy, injections, surgery, and other forms of care, but the biggest problem facing most of these patients is that they do not have a specific diagnosis.

The proper way to treat any medical problem is to find the exact cause of the problem and then attempt to fix it. When it comes to spine pain—whether it is neck or back pain, or some form of pain that runs down the arm, leg, hip, or shoulder that is created by the spine—I have noticed that instead of locating the specific problem in the spine and then finding a way to eliminate it, the usual medical care is to treat every back and neck problem the same way. This may be the same type of physical therapy, the same type of exercise program, and/or the same type of injections. You will find that as you read this book, depending on the exact structure in the spine that is creating your pain, the therapy, the injections, and your exercise program can be completely different. I see patients all the time for whom one essential issue has not been resolved: they do not have a specific diagnosis!

Okay, I know I am repeating myself, but this is an important point that I am always trying to get across to patients and other medical practitioners. You may be wondering why there could be an issue like this with all the technology that now exists. Why not just get an MRI of the area that is creating your pain, find the inflamed area on the MRI that is creating your pain, and then treat it? I am going to discuss this in detail later in this chapter, but the simple answer to that question is that an MRI just shows wear and tear and not pain. And we all have wear and tear as we age. Most people will go through their life with herniated discs and arthritic joints in their spine with no pain. The only time you are usually going to hurt is when the disc, the nerve, or the joint becomes inflamed, and the MRI does not show inflammation. You cannot make a diagnosis by just obtaining an MRI.

The care of the spine that is discussed in this book rests on one simple premise: diagnose first and then treat.

Actually, the first step isn’t diagnosis at all. The reality is that eighty percent of all people with acute back or neck pain will get better over a period of weeks with no medical treatment at all—because the body will heal itself by eliminating the inflammation. Many people during their lifetime are going to have neck, mid-back, or lower back pain because of poor body mechanics or a specific twisting turning motion that tweaked the disc, nerve, or joint. This pain is usually due to a disc, nerve, and/or joint in the spine that becomes red, hot, swollen, and painful as the body reacts to the injury. The swelling and pain go away over several weeks as the body goes to work eliminating this inflammation. Therefore, it is not necessary to find a specific reason for your pain during the first several weeks, because your pain will probably resolve no matter what is done. The only reason not to treat your pain conservatively during the first month or so is if you have severe numbness or weakness in your arms or legs or if the pain is not controlled by oral medications.

What this means is that if you have an acute attack of back or neck pain, just try to treat it with your favorite combination of anti-inflammatory drugs, ice, heat, and pain medication, and try to stay as active as possible without creating excess pain. You need to wait it out and see whether you are going to be one of the eighty percent who will get better without doing anything else. If you want to see your local chiropractor or physical therapist, go right ahead, as these practitioners can be helpful during this period. The information on therapy and exercises in Chapter 17 can be used in conjunction with your therapist or chiropractor, but during this period, do not do any specific exercises that create pain. The body is trying to tell you something. Listen to it.

Do not get caught up with a lot of medical mumbo-jumbo during this time. You may hear that you need multiple days of traction, a series of injections, realignment of your hips, and maybe even a surgery or two. Ignore this advice at this time. Also, forget the running, weight lifting, yoga, and anything else that involves twisting and pounding of your spine. This is a period of healing. Once the pain gets better, skip down to Chapter 17 in this book and go from there. I put this chapter at the end of the book for a reason. Most patients are able to exercise much better after their acute pain is gone and they know specifically what is creating their pain. So even though you may be able to use some of these exercises during your acute pain, the most beneficial time is after you are feeling better. What I am telling you is that no matter what area in your spine is creating the pain, most of the time the body will eradicate the inflammation. A diagnosis is not important during the first several weeks of your pain unless you are having significant numbness or weakness.

If your discomfort persists after four to six weeks, then it is time to read the rest of this book. The first thing you need to do is to locate where your pain is coming from. You can start by marking the areas where you feel the discomfort on an outline of the human body. I am going to show you an illustration of the front and back of the human body, which is called a pain diagram (Picture 1). It allows patients to draw on it to show the exact area where they feel their discomfort. I have patients complete this drawing before I see them. So if you are hurting at this time, you can draw where your pain is located on this image.

Picture 1

Pain diagram.

You may be wondering why I am asking you to draw on a picture before telling you anything about the spine. The answer is that this is the most important “secret” piece of information that you will want to read about in this whole book! Just matching your pain drawing with three pictures, Picture 2, Picture 3, and Picture 5, which show where structures in the spine create pain, will enable you to narrow down the problem that is creating your pain.

Picture 2

This picture shows where the nerves in the spine create pain on the surface of the body when they are inflamed.

Picture 3

Muscles that hurt when specific nerves in the cervical spine are inflamed.

Picture 4

Areas of the body where you may feel pain when the C7 nerve is inflamed.

Picture 5

Inflamed nerves in the lumbar spine create pain in the muscles and bones of the hip, buttock, and groin.

The next picture that I am going to show you is a front and back picture of the human body that specifically shows the different areas where you will feel pain on the surface of the body when the nerves in the spine are inflamed (Picture 2).

You will see a letter and a number attached to each area. The neck is called the cervical area, the mid-back is the thoracic area, and the lower back is the lumbar area. Therefore, a C in front of the number corresponds to the cervical or neck area, the T stands for mid-back or thoracic area, and the L stands for the lumbar or lower back. The S in the picture refers to the sacral or tailbone area. The number attached to the letter gives the specific nerve. For example, C6 stands for the sixth cervical nerve, the L5 nerve is the fifth lumbar nerve, and T10 stands for the tenth thoracic nerve. If you follow each one of these nerves, you will see that each has a specific path. The cervical nerves start in the neck and go down into the shoulders and arms. The thoracic nerves start in the mid-back and wrap all the way around to the front of the body. The lumbar nerves start in the lower back and go down the front and back of the legs. The sacral nerves primarily cover the pelvic area.

If you drew on the pain diagram in Picture 1, you can now match it to Picture 2. For example, if you drew your pain on the side or back of the leg, it would match L4, L5, or S1. If you drew your pain in the area of the shoulder blade, it would match T4 or T5. If you drew your pain over the hip, it would match the L4 or L5 nerve. If you drew over the back of the neck, it would match C5, C6, C7, or C8. Remember that Picture 2 points out only where the nerves in the spine create pain on the surface of the body. You should keep in mind other possibilities. The first is that the problem could be with a joint or muscle, and not the spine. So, if your shoulder hurts, your pain could be coming from your shoulder joint, the muscles around the shoulder, or the nerves that run from your spine to your shoulder, which would be the C5 or C6 nerves. If your knee hurts, the knee joint could be inflamed, or the L3 or L4 nerve root could be...